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Ethics... Exoploring Privacy and Confidentiality: Gray Areas
Now this is pretty clear cut. The correct answer is D, and you might reference the NASW Code of Ethics, Section 1.07(R). A, B, and C are incorrect, because they assume that exceptions can be made to confidentiality protections after the person dies.
Section 12 involves the patient or client’s right to know, and it raises the ethical issue regarding confidentiality as to how much information should be shared with family members, and also regarding patient or client self-determination.
The basis of this Section... is a case study by Dr. Saladay, who writes regarding ethical problems: How much information does the patient have a right to know about his own condition?
♦ Case Study Analysis: Alvin's Biopsy
So what's the problem? Alvin's son and daughter believe that if he finds out about the pathology report, he'll go into a tailspin because he thinks cancer is a death sentence.
Normally I believe in full disclosure to patients. But under the circumstances, what's the point of telling Alvin about the biopsy results? Ethical behavior involves what's fair and right. In this situation, you think that the right thing would be to protect Alvin by withholding information about the biopsy results. After all, isn't his peace of mind the most important thing?
Before deciding, let's consider the main reason Alvin's children don't want to inform him about his biopsy results: They believe the news will be too upsetting for him. But why do they think he can't handle this information, especially when the facts are overwhelmingly positive? Does he have a history of significant depression? Is he being treated for depression now? Is he still grieving for loved ones who died of cancer? Has he ever been suicidal? Consider also the consequences of withholding information about his prognosis. How can he participate in treatment decisions if he's ignorant about his condition?
If you suspect that he would "go into a tailspin," as his family believes, you need to address the key mental health issues before tackling this one. If not, let Alvin's physician take the lead. As advocates for the patient, the nursing staff can work with the physician and family to reconsider Alvin's right to know. Educate Alvin's children about his condition. Emphasize the importance of telling the truth to ensure that he gets appropriate follow-up treatment and to foster trust between Alvin and his caregivers.
Alvin also needs education about his condition, so he can continue his recovery with the understanding that cancer isn't an automatic death sentence.
Online Continuing Education QUESTION
Remember, the purpose of this course is to stimulate your thinking about ethics and confidentiality.
As is brought out in this Home Study Course, confidentiality practices, long believed invulnerable to change, are now being questioned. The advent of computers, for example, is raising doubts about whether confidentiality, because of this sharing of information, is becoming more of an outdated concept.
Confidentiality has become a highly complex ethical and legal issue, needless to say. Those professionals unaware of its complexities generally function with a few simple guidelines such as, "don't talk about clients outside work" and "when a subpoena arrives, you have to answer it." Unfortunately, numerous sticky situations arise in daily practice, and clinicians, administrators, and those concerned with personnel matters often find the standard guidelines inadequate.
In short, given the uncertainty that characterizes large areas of health professions policy and practice, health professionals necessarily must be risk-takers, innovators, and probability seekers.
Let's look back over the Home Study Course in summary:
In Section 2, a devil's advocate position toward ethics was taken in "Who Needs Ethics anyway." Prejudice was examined in light of emotions versus what is right.
Remember the purpose of this course is to stimulate your thinking about ethics and confidentiality. This Home Study Course is one in our Ethics series. We thank you for selecting us to fulfill this continuing education requirement, and hope you will consider our other Ethics courses in this series as future CE's are required. We also offer audio Home Study Courses, usually 10 hours in length, in other areas as well. I look forward to talking to you again in your next Home Study Course sponsored by the Healthcare Training Institute.
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